Lichen planus

Question 1

What is the incidence of lichen planus?

Answer 1

1-2%

Question 2

Is liken plnus more common in males or females?

Answer 2

females

Question 3

What is the underlying process in LP?

Answer 3

Immunologically mediated mucocutanoues disorder caused by action of CD4 and CD8 cells which targets keratinocytes

Question 4

What factors are caustive agents in LP?

Answer 4

Mostly idiopathic
drugs: antimalirials, antihypersentivies, anutidiabetic, antirhematic
Medical: SLE, hypertentsion, diabetes, liver disease
Amalgam

Question 5

What sites can be affected by LP?

Answer 5

wrists, scalp, mouth, genital

Question 6

What are the 6 types of LP?

Answer 6

Erosive
atrophic
plaque like
reticular
papular
bullous

Question 7

What two types of LP are associated with the highest risk of malignancy?

Answer 7

Erosive and plaque like

Question 8

What would you do clinically to aid diagnosis?

Answer 8

Biopsy (incisional) and Bloods (possible SLE)

HCV serology, AI profile, epidermial patch test

Question 9

What features would the histopathoology show?

Answer 9

band like T cells infiltration along the basement membrane
Acanthosis and atrophy
basal cell liquefactron
saw shaped rete ridges
hyperparakeratinisation 
may show signs of dysplasia
Ulcerated lesions may not show keratosis

Question 10

What is the management of LP?

Answer 10

Good OH
remove any possible agents
topical steroids
Betnosel: betamethosone mouth rinse
Barrier agent eg Orabase which is carboxymethylcellulose 
Antiseptic agents eg CHX

Moderate to severe inflam: refer to specialist and use high potency topical steroids such as clobetesol 0.05% mixed with Orabase and topical tacrolimus 0.01% mixed with Orabase 1:1

Systemic therapy: prednisalone starting at 40mg and reduce over month and long term systemic therapy used in recalcitrant OLP eg azothiarpine

Question 11

What are the features of OLP?

Answer 11

usually bilateral
usually affects the buccal mucosa
Desquammative gingivitis 
Mucosal erosion with frank ulceration
Bullous lesions

Question 12

What may also be associated with oral lichen planus?

Answer 12

Skin lesions

Question 13

Which extra oral sites are associate with lichen planus?

Answer 13

Skin
Scalp
Genital
Oesophageal

Question 14

What are the skin lesions in lichen planus?

Answer 14

Wrist ankles and Lowe back
Itchy
Purple red papules sometimes have white streaks known as whickams striae
3-5mm in diameter
Hypertrophic lichen planus which appears on the ankles

Question 15

What happens when the extra oral lesions have cleared?

Answer 15

The skin in this part appears discoloured

Question 16

T/F Lichen planus can affect the nails?

Answer 16

T

Question 17

T/F lichen planus can affect the scalp?

Answer 17

T

Question 18

How do nails appear in lichen planus?

Answer 18

Thinner
Ridges
Grooves
Or sometimes darker and nails shed of stop growing

Question 19

What can happen to the hair in the region of the SCAP where LP has affected?

Answer 19

Can be permanent hair loss

Question 20

What are the complications of OLP?

Answer 20

Pain
Periodontal attachment loss
Malignancy risk

Question 21

T/F the histology between OLL and OLP is indistinguishable, ?

Answer 21

T

Question 22

What type of disease may lead to Lichen planus type lesions?

Answer 22

SLE/DLE
GvHD
Hep C with OLL

Question 23

How does indirect IF work?

Answer 23

Clotted blood sample
Placed into serum and incubated with a substance eg monkey oesophagus, AB bind to the targets and then an antihuman AB with a fluorescent marker is used to show binding pattern